cord wrapped around neck and delivery - Mothering Forums

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#1 of 4 Old 12-14-2006, 04:59 PM - Thread Starter
 
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Can some of you please explain how it is that cords around the neck are sometimes deliverable, and sometimes not. I've seen pictures of vb where the baby had the cord wrapped around the neck and was totally fine, but then I have a friend whose brother suffered major trauma from the cord around the neck. He has severe mental difficulties that are all attributed to the birth and the cord wrapped around the neck.

How does a mw "know" when a cord is wrapped around the neck and when it might be a problem? My vbac had a "true knot" and I know that can cause some problems, although my birth was fine.

I'm just trying to understand all these things. Please give me all your opinions.
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#2 of 4 Old 12-14-2006, 06:37 PM
 
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Well, I'm not going to be much help, but I can tell you what happened at my last birth. The cord was wrapped around my daughters body 3 or 4 times....this made it where she was unable to drop. I'm guessing the same can happen with any baby who is wrapped in the cord so it doesn't allow the baby to drop suffiently.... If the baby is close to the placenta and the wrapping occurs, that means there isn't much room for the baby to drop.

I had a hospital birth, but we had no idea my daughter was wrapped like that. (I had an external version 2 weeks before....seemed like everything went well at the time.) But after 60 hours of drug free labor, 9+ cm, and she still had not dropped....we knew something was wrong. Only at the cesarean birth did we find out about the cord being wrapped around her body. She was pretty unresponsive at birth....so I'm glad I didn't wait any longer. Otherwise, the outcome may have not been a healthy baby...
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#3 of 4 Old 12-14-2006, 09:11 PM
 
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It is very common for cords to be wrapped around babys' necks (I've heard percentages as high as 50%). It seems that sometimes providers use this as a "reason" or "excuse" for interventions or distress, but by itself it just doesn't make sense. Like you said, often babies are fine.

Sometimes connections can be made between a cause and effect that are probably not related. Birth defects or mental difficulties may have existed before the birth, and since the only "abnormal" sign was a cord around the neck, this was seen as the cause. I don't know of any research that says there is a direct correlation.

Watching a baby's heart rate during labor & birth are important. If baby's heart rate shows consistent signs of distress (i.e., late decelerations during contractions), this may be a sign that a cord around his/her neck (or something else) is limiting blood supply. This would be one definitive sign that there is a problem somewhere, whether the cord is wrapped or not.

The other sign of a problem related to a wrapped cord would be, as the above post said, that baby does not descend, despite an opening cervix.

Hope that helps!
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#4 of 4 Old 12-14-2006, 09:54 PM
 
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cord wrap is common very common. there is some evidence that greater than 3 wraps is related to a child with some mental/brain problems but which comes first... is not known and it isn't 100% of those kids either it is just a tendency--
until recently I am adding this abstract and I want to say something about it first and that is the common care of a tight cord in a medical setting is to cut it- this would make for a baby that is somewhat stunned- but as you can see recovers well- additionally there are comments about mec in post term babies and the studies on that are post term babies have mec more often and are not sick as a result of it.--
Obstet Gynecol. 2005 Jul;106(1):23-8.

Comment in:
Obstet Gynecol. 2005 Dec;106(6):1417; Author reply 1417-8.

Nuchal cords in term and postterm deliveries--do we need to know?

Schaffer L, Burkhardt T, Zimmermann R, Kurmanavicius J.

Department of Obstetrics, University Hospital Zurich, Switzerland.
leonhard.schaeffer@usz.ch

OBJECTIVE: To analyze the effect of nuchal cords on perinatal features at delivery of term and postterm pregnancies. METHODS: A total of 11,748 women with planned vaginal deliveries, including 9,574 term and 2,174 postterm deliveries, were analyzed for intrapartum events, clinical peripartum management, mode of delivery, and neonatal outcome. The presence of nuchal cords was diagnosed clinically at the time of delivery. Data were obtained from our perinatal database between 1995 and 2004 for retrospective analysis. RESULTS: The
incidence of nuchal cords in term and postterm deliveries was 33.7% and 35.1%, respectively. Multiple nuchal cords were present in 5.8% of term and 5.5% of postterm deliveries. Intrapartum signs of fetal compromise were increased in all groups, albeit not all reaching statistical significance in postterm deliveries. Meconium staining was significantly increased only in multiple nuchal cords of postterm deliveries (42.1% compared with 30.1%, P < .05). Mode of delivery was unchanged in all nuchal cord groups. Unfavorable neonatal blood gas values were significantly more frequent in all nuchal cord groups. Nevertheless, 5-minute Apgar scores less than 7 were not more common, and admission to neonatal unitwas not required more frequently. Neonatal mean birth weight was significantly
lower in all nuchal cord groups. CONCLUSION: Nuchal cords do not influence clinical management at delivery, and neonatal primary adaption is not impaired. Our data show that ultrasonographic nuchal cord assessment is not necessary at the time of admission for delivery. LEVEL OF EVIDENCE: II-3.

PMID: 15994613 [PubMed - indexed for MEDLINE]
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